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Antimicrobial resistance (AMR) is a critical global health threat, with drug-resistant infections projected to cause up to 10 million deaths annually by 2050. India bears a disproportionate share of this burden. Dental practitioners contribute approximately 10% of national antibiotic prescriptions; however, antimicrobial stewardship (AMS) in dental settings remains underdeveloped, with no national dental-specific guidelines. This systematic review with narrative synthesis evaluates AMR awareness and AMS implementation among Indian dental professionals.
Methods:
A systematic review with narrative synthesis was conducted in accordance with PRISMA 2020 guidelines. Five databases were searched for studies published between January 2014 and December 2024. Eligible studies of any design examined AMR awareness, AMS behaviors, or antibiotic prescribing practices among Indian dental practitioners. Methodological quality was independently appraised using CASP checklists. Due to substantial heterogeneity across study designs and outcomes, findings were synthesized narratively and analyzed thematically.
Results:
From 1,852 records, 14 studies involving 3,602 participants were included. All studies referenced guidelines or clinical pathways. Prescribing practices were the most frequently assessed outcome (12/14; 86%), followed by compliance (9/14; 64%) and knowledge or awareness (6/14; 43%). Key findings included significant knowledge–practice gaps, inappropriate prescribing patterns, and the absence of structured stewardship infrastructure. Facilitators included baseline AMR awareness and professional willingness to engage, while barriers included curriculum deficiencies and limited access to guidelines.
Conclusions:
Structured dental AMS programs are both urgently needed and feasible in India. Addressing modifiable drivers through national prescribing guidelines, integrated AMS education, and audit and feedback systems is essential to support AMR containment.
Electoral participation among immigrants is frequently examined through the lens of residence country integration policies and institutional access. However, immigrants arrive with embedded values and political attitudes developed through early political socialisation in their country of origin, which may influence their engagement with democratic institutions long after migration. Grounded in theories of political (re)socialisation – exposure, resilience, and transferability – and drawing on the ‘impressionable years’ argument in resilience theory, we hypothesise that pre-migration political culture influences electoral participation, but its influence varies across generations. Specifically, we examine how pre-migration exposure to different political regimes affects electoral behaviour and how the timing of arrival (before or after age 13) and the length of residence moderate these effects. To test the hypotheses, the analysis draws on European Social Survey (ESS) data (Rounds 5–11), covering 23 EU member states. We focus on citizens of foreign origin, including 14,216 first-generation, 3,620 1.5-generation (arriving before age 13), and 5,359 second-generation immigrants. Using additional measures from the Varieties of Democracy (V-Dem), we employ logistic regression models that integrate individual-level predictors with origin-country political culture, derived from migrants’ or their parents’ countries of birth. Our findings speak to all three strands of the political resocialisation framework. Early arrival and longer residence are associated with higher electoral participation, while pre-migration political socialisation continues to shape political behaviour after migration. Most notably, we find that first-generation immigrants socialised under authoritarian regimes exhibit higher electoral participation than their peers from democratic origins, suggesting the presence of a reactive mobilisation mechanism.
Digital mental health tools are increasingly available to university students, yet evidence remains limited on how Chinese students engage with these resources and how such engagement shapes help-seeking. This exploratory study examined Chinese postgraduate students’ lived experiences of using digital mental health tools and the factors influencing engagement and perceived value. Semi-structured interviews were conducted with 10 postgraduate students (aged 23–30) who had used mental health apps, AI chatbots, or online counseling services. Data were analyzed using Interpretative Phenomenological Analysis. Four themes emerged: accessibility and anonymity lowered barriers to help-seeking; digital tools supported self-regulation but were viewed as complements rather than substitutes for professional care; sustained engagement was limited by impersonal responses, usability issues, credibility concerns, and digital fatigue; and stigma, self-reliance, and peer norms shaped willingness to seek support. Participants also highlighted concerns about safety and escalation pathways. Overall, digital tools may provide timely, low-threshold support, but their impact may be improved through stronger personalization and governance and through blended models that integrate peer and professional care with timely escalation. Given the small, context-specific sample, these results are exploratory and intended to generate hypotheses rather than provide generalizable conclusions.
The objective of this study is to examine the policies of the Russian Empire and Persia regarding the election of the Catholicos of All Armenians. The expansionist ambitions of the Russian Empire in the South Caucasus led to confrontation with Persia, and within this context the cultivation of a pro-Russian worldview among the Armenian population became a priority for Russian authorities. Consequently, the Catholicosate of All Armenians—the most influential Armenian institution of the period—emerged as a target of both Russian and Persian intervention.
The election of the Catholicos thus became a primary foreign policy issue for the two empires. The electoral process itself reveals divisions within the Armenian clergy, as rival factions sought to establish a Catholicos under Russian or Persian patronage. Taking advantage of these circumstances, Tsarist authorities actively intervened, promoting their preferred candidates and thereby breaking with the traditional practice of autonomous election.
This study draws on archival documents from the Catholicosate of All Armenians, which provide the basis for a comprehensive analysis of the election process, the responses of the Armenian clergy, the manifestations of Russian-Persian rivalry, the resulting diplomatic confrontations, and the involvement of the Ottoman Empire. By systematically reconstructing these events from original sources, the study highlights the ways in which imperial rivalries directly shaped Armenian ecclesiastical life, offering new insights into the intersection of religious authority and regional power politics in the South Caucasus.
Despite the availability of straightforward and economic interventions to prevent HAIs, these unintentional adverse events still pose a significant challenge to public health globally. We aimed to evaluate the outcomes of a nationwide project designed to mitigate HAI incidence in intensive care units (ICUs) using the Model of Improvement framework.
Methods:
A Quality Improvement (QI) study assessing the outcomes of a two-year initiative in Brazilian ICUs from September 2021. A customized Collaborative methodology was applied to mentor and enhance the capabilities of healthcare workers, equipping them with evidence-based, structured, systematic, and auditable QI strategies (prevention bundles) to improve patient care outcomes. A one-year preintervention baseline incidence was established for the three critical HAIs: central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI), to compare with the intervention period.
Results:
The initiative encompassed 188 ICUs (169 adults, 11 pediatric, and eight neonatal), recording substantial reductions in HAI incidence density: by 43% for CLABSI (from 5.5 to 3.2 per 1,000 catheter-day), by 51% for VAP (from 13.6 to 6.7 per 1,000 ventilator-day), and by 55% for CAUTI (from 3.2 to 1.4 per 1,000 catheter-day), irrespective of age. Implementing this QI strategy prevented an estimated 7,342 infections.
Conclusion:
Our initiative has been demonstrated to be a feasible and valuable strategy for preventing HAIs in critical care settings. The success of this approach emphasizes the potential for its broader application and reinforces the need for systematic, evidence-based interventions in healthcare settings.
This Article explores how rape is criminalized through the design of criminal provisions, with particular attention to offense-construction principles. While criminalization theory typically asks whether conduct should be criminalized, this study examines the equally important question of how a criminal provision should be structured. Using a comparative legal and empirical analysis of legislative materials from Belgium, Germany, the Netherlands, and Sweden, the article identifies the principles that guide legislators in shaping the prohibition, legal classification, and sanction of rape. The analysis shows that legality, coherence, internal subsidiarity, effectiveness, guilt, retrospective proportionality, and legitimating principles such as harm, wrong, and legal interest play central roles, though their relative importance differs across jurisdictions. The actus reus receives the most detailed legislative attention, especially where consent-based models replace coercive ones. The study also finds that explanatory memoranda are most effective when principles are used in combination rather than in isolation. Overall, the article argues that offense-construction principles can improve the clarity, accessibility, and internal consistency of rape legislation, while also ensuring that legal labels and penalties better reflect the seriousness of the offense.
The Indian Telecommunications Act 2023 has sparked significant discourse on whether the law perpetuates a colonial legacy, as its critics claim, or represents a decolonial turn, as asserted by the government. This Article argues that the Act does not constitute a genuine rupture but instead perpetuates existing power structures. Using a post-colonial lens, I trace the historical development of the telegraph network and its regulation during the colonial period, examining how the legal framework evolved post-independence, leading to the Telecommunications Act.
The Article analyzes how the telegraph, which was critical for British victory in the 1857 revolt, expanded significantly, fueled by colonial anxieties. It explains how the telegraph and its regulations became integral to the British emergency governance apparatus, essential for surveillance, control, and domination over the population. During this period, I identify three key aspects that constitute the colonial disposition underlying telegraph regulations: technology as control, state-subject dynamics, and relentless accumulation. I demonstrate how over a period of 150 years, despite changes in the legal framework and underlying technology, these key characteristics of colonial continuity have remained the same. The Article concludes that the Telecommunications Act fails to dismantle the colonial architecture, instead expanding its reach.
Irrotational monochromatic surface gravity waves possess a mean Lagrangian drift which transports mass and enhances mixing in the upper ocean. In the ocean, where many surface waves are present, it is commonly assumed that the mean Lagrangian drift can be computed independently for each wave component and summed. Here we show, using laboratory measurements and fully nonlinear simulations of two-dimensional steep focusing wave packets, that this assumption underpredicts the average transport in regions of wave focusing by up to $30\,\%$. To explain these enhancements, we derive a new exact method for constraining the local mean Lagrangian drift in general flows by working in the Lagrangian reference frame. From this method, we derive an expression for the local mean Lagrangian drift in deep-water narrow-banded wave fields governed by the nonlinear Schrödinger equation (NLSE) that predicts near-surface enhancements when waves focus and steepen. The theoretical predictions of the local transport agree with the laboratory measurements, particularly for smaller bandwidth packets where the NLSE approximation is most valid. These findings highlight that it is the local steepness of the wave field, not just the sum of the steepnesses of the linear (non-interacting) wave components, which sets the strength of these enhancements.
We analyze district‑level data for paddy, wheat, and millets (2010–2019) across India to identify yield hotspots with consistently high or rising productivity and coldspots with persistent declines. Spatial clustering and regression analyses show that weather, irrigation, fertilizer use, and farmers’ mobile-based information access shape yield performance. Coldspots produce roughly half the yield of hotspots due to lower input and information use. Hotspots cluster in north and southern India, while coldspots dominate the west, east, and northeast. Average yield gaps for paddy, wheat, and millets are 2.0, 2.4, and 1.0 t ha−1, respectively. Closing these gaps could substantially raise farm revenues.
Prisons are high-risk environments for the spread of tuberculosis (TB). We investigated an ongoing prison-associated TB cluster to identify common exposures. We defined cases as residents in England with laboratory-confirmed TB belonging to the genetic cluster. We extracted records from the National TB Surveillance System, linked to prison operational data, and conducted descriptive analysis of demographic, clinical, and phylogenetic data. Years were masked for anonymity. Over six years, 12 individuals were identified, predominantly male (83%) and median age 34 years, in London, East Midlands, and East of England. Prison history was noted for 7/12 (58%) at 13 prisons. Everyone without prison history completed treatment, but 2/7 with prison history were lost to follow-up and 5/7 were still in treatment or outcome not evaluated. We identified frequent prison transfers and concurrent stays of four individuals at Prison B, and two at Prison G. Phylogenetic analysis indicated distinct sub-clusters with and without prison history, suggesting expansion of the cluster from community into prisons. Prisons continue to play a role in TB in England. Factors such as frequency of transfers could hinder treatment completion and control of transmission. Combining phylogenetic, epidemiological, and prison operational data facilitated investigation of transmission pathways.
This study examined the development of bilingual lexical networks in adolescence through word association task and network analysis. Participants were Chinese–English bilinguals in Grade 8 (middle school; aged 13–14 years) and Grade 11 (high school; aged 16–17 years). Networks were constructed based on word association responses separately for each grade and language, and structural properties of networks were computed. Results showed that from Grade 8 to Grade 11, the Chinese networks displayed increased within-group convergence while maintaining overall structural stability and small-world features. In contrast, the English networks expanded in size, with longer average shortest paths, higher local clustering, and greater modularity (Q), reflecting rapid growth and restructuring, while also exhibiting small-world features. Across grades, L1 networks remained larger and more structured than L2 networks, though the gap decreased over time, indicating increasing cross-language similarity. These findings provide new insights into bilingual lexical development during the adolescent years.
To provide a scientific basis for establishing a portion size database for dietary assessment and nutritional education, we determined the portion sizes of commonly consumed food groups among Japanese children and adolescents aged 3–17 years. This study analysed 8-d weighed dietary record data from a nationwide survey conducted between November 2016 and August 2020. Participants were grouped into preschoolers (3–6 years, n 572), elementary schoolchildren (7–12 years, n 406) and middle/high school students (13–17 years, n 379). Age- and sex-specific portion sizes of seventy-three food groups were calculated as weighted averages of median portion sizes of the food items within each group, using the number of consumers for each item as weights. Overall, older participants had larger portion sizes than younger participants, but the magnitude of this difference varied between sexes and food groups. For most food groups, middle/high school students consumed 1·2–1·5 times (29 and 45 food groups for boys and girls, respectively) or 1·6–1·9 times (32 and 18 food groups for boys and girls, respectively) larger portion sizes than preschoolers. Portion sizes among middle/high school students were at least twice as large as those among preschoolers for ten food groups in boys, including staple foods, pork/beef, some vegetables, some beverages and salty snacks, but only for three food groups in girls. In conclusion, these differences in portion sizes according to age, sex and food group should be taken into account when assessing dietary intake and designing nutritional education for portion size control.
Mohenjo-daro was a major city of the Indus Civilisation (c. 2600–1900 BC), with excavations revealing evidence for public infrastructure, civic amenities and hundreds of residences. Archaeologists traditionally assume that urbanism is accompanied by economic stratification, but, at Mohenjo-daro, qualitative evidence of inequality is absent. Drawing on early excavation data, the authors here calculate Gini coefficients of residence area, providing a quantitative proxy of economic inequality. Their results indicate that Gini coefficients, and thus inequality, declined over time, coinciding with increased prosperity and the development of the city’s street plan, indicating that governance likely helped limit economic inequality.
This study investigates how in-game virtual currencies influence consumer spending behaviour. In an incentivized randomized controlled trial with 753 UK participants, we estimate the willingness-to-pay (WTP) for loot boxes represented as risky and ambiguous lotteries. We test the effects of virtual currencies, money illusion, and cognitive-demanding (non-intuitive) exchange rates, three practices commonly used to sell loot boxes. Our results show that WTP is significantly higher when transactions are conducted in virtual currencies with a 1:1 exchange rate compared to British pounds, contributing to the debate on the neutrality of virtual currencies and experimental currency units. Moreover, participants in our study are affected by money illusion distortions, regardless of the exchange rate’s intuitiveness. However, we find no evidence that non-intuitive exchange rates affect participants’ WTP compared to intuitive exchange rates of comparable size. These findings highlight the behavioural distortions induced by common monetization practices in games and provide empirical support for the European Commission’s call for stricter regulation of virtual currencies in digital environments.
In 1971, Davies proved that finitely many parallel line segments can be simultaneously fully rotated in an arbitrarily small area. In this paper, we show that an even stronger statement holds: The unit square can be fully rotated in such a way that each initially vertical line segment sweeps a set of small area.
A set in ${\mathbb{R}}^n$ is said to have the strong Kakeya property if for any two of its positions, the set can be continuously moved between these two positions in an arbitrarily small volume. We use the above result to show that a wide family of sets in ${\mathbb{R}}^3$, for instance, the lateral surface of a cylinder, have the strong Kakeya property.
This paper presents research on the economic value of wildlife watching trips. Our analysis accounts for wildlife mobility and connectivity between viewing sites, which could bias basic welfare calculations, by linking demand to spatially connected, site-specific populations. We examine the potential for bias with an application to birdwatching in Indiana. Viewers value species diversity and population abundance, particularly sandhill cranes. Scenarios that ignore spatial connectivity overstate welfare losses by up to 34%.